The assessment of health-related quality of life in relation to the body mass index value in the urban population of Belgrade

Mental health and quality of life in different obesity phenotypes: a systematic review

Objectives

It has been suggested that obesity phenotypes are related to mental health problems and health-related quality of life (HRQoL). However, there is no certain consensus. This systematic review aimed to evaluate the association between different obesity phenotypes with common psychiatric symptoms and HRQoL.

Methods

Electronic databases i.e. PubMed, Scopus, EMBASE, and google scholar were searched until September 2021, to identify studies that investigated associations between the obesity phenotypes with psychiatric symptoms and/or mental and physical HRQoL. Two researchers independently checked titles and abstracts, evaluated full-text studies, extracted data, and appraised their quality using the Newcastle–Ottawa Scale.

Results

Eighteen studies, with a total of 3,929,203 participants, were included. Of the studies included in this systematic review, 10 articles evaluated the association between obesity phenotypes and psychiatric symptoms, while six papers investigated the association between HRQoL and obesity phenotypes, and two studies assessed both. As a whole, the findings of these studies suggest that obese individuals with a favorable metabolic profile have a slightly higher risk of mental health problems and poor quality of life, however, the risk becomes larger when obesity is combined with an adverse metabolic profile. So, metabolically healthy obesity may not be a completely benign condition in relation to mental disorders and poor quality of life.

Conclusion

According to published research, obesity is likely to increase the risk of mental health problems and poor quality of life when metabolic disturbances are present.

Decreased Quality of Life Is Significantly Associated With Body Composition in Patients With Nonalcoholic Fatty Liver Disease

BACKGROUND & AIMS

We studied impaired quality of life (QOL) and its determinants among individuals with nonalcoholic fatty liver disease (NAFLD).

METHODS

We collected data from 341 patients with NAFLD who completed the short form 36 (SF-36) questionnaire. Body composition and liver fibrosis were assessed in patients with NAFLD using bioelectrical impedance and transient elastography, respectively. Advanced fibrosis was defined as liver stiffness measurements (LSMs) of 12.1 kPa or greater. SF-36 scores of patients with NAFLD were compared with SF36 scores of individuals with chronic medical illnesses and the general population obtained from the published literature.

RESULTS

Among patients with NAFLD, percent body fat was negatively associated with scores from all 8 SF-36 scales, whereas lean body mass was positively associated with scores from 5 of 8 SF-36 scales. On multivariable analysis, SF-36 PF scores were negatively associated with type 2 diabetes, body mass index, and LSM and positively associated with lean body mass and level of alanine aminotransferase. Patients with NAFLD, and even those without advanced fibrosis, had significantly lower mean QOL scores than the control group or the general population.

CONCLUSIONS

Individuals with NAFLD, even those without advanced fibrosis, have lower QOL than controls. Body composition associates with QOL in patients with NAFLD; both of the modifiable factors independently associated with QOL are related to body composition. Further studies are needed to investigate if interventions to improve body composition can increase QOL for patients with NAFLD.

Determinants of Health Status Three to Six Years After Surgical Treatment of Closed Ankle Fracture and Comparison with the General Population: A Historical Cohort Study

Background:

The purposes of the present study were to identify the determinants of health status 3 to 6 years after open reduction and internal fixation (ORIF) for the treatment of closed ankle fracture and to compare the health status of patients who had undergone this procedure with that in the general population after adjusting for sociodemographic variables, body mass index (BMI), and smoking status.

Methods:

The present study was a historical cohort study combined with a postal survey. In total, 1,149 patients who underwent ORIF for the treatment of closed ankle fractures at 2 hospitals were eligible for chart review; 959 with low-energy fractures were eligible for a postal survey, and 471 (49%) responded to the Short Form Health Survey-36 (SF-36) health status questionnaire and provided data on BMI. Determinants of the physical functioning (PF), physical component summary (PCS), and mental component summary (MCS) scores of the SF-36 were analyzed by means of multivariable linear regression analysis. The health status of patients with an ankle fracture (n = 471) was compared with that in a sample of the general population (n = 5,396) by means of multivariable regression.

Results:

Age, American Society of Anesthesiologists (ASA) class III, and complications following surgery were associated with PF and PCS scores, and a BMI of ≥30 kg/m² and current smoking status was associated with PF and MCS scores. However, the PF, PCS, and MCS scores of patients with ankle fractures did not differ from those of the general population, with unstandardized regression coefficients of 0.25 (95% confidence interval [CI], –1.67 to 2.16; p = 0.80), 0.67 (95% CI, –0.35 to 1.70; p = 0.199), and –0.57 (95% CI, –1.63 to 0.49; p = 0.29), respectively.

Conclusions:

Age, ASA class III, and complications following surgery were associated with PF and PCS scores at 3 to 6 years after surgery for the treatment of closed ankle fractures. However, the health status of patients with ankle fractures did not differ from that in the general population after adjusting for differences in demographic variables, BMI, and smoking status.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Obesity, metabolic abnormality, and health-related quality of life by gender: a cross-sectional study in Korean adults

PURPOSE

This study sought to compare the association between health-related quality of life (HRQoL) and four body health types by gender.

METHODS

The study included 6217 men and 8243 women over 30 years of age chosen from a population-based survey. Participants were grouped by body mass index and metabolic abnormality into four types: metabolically healthy normal weight, metabolically abnormal but normal weight (MANW), metabolically healthy obesity (MHO), and metabolically abnormal obesity (MAO). HRQoL was measured using the EQ-5D health questionnaire. The outcomes encompassed five dimensions (mobility, self-care, usual activity, pain/discomfort, and anxiety/depression), and the impaired HRQoL dichotomized by the EQ-5D preference score. Complex sample multivariate binary logistic regression analyses were conducted to adjust for sociodemographic variables, lifestyle factors, and disease comorbidity.

RESULTS

Among men, those in the MANW group presented worse conditions on all dimensions and the impaired HRQoL compared to other men. However, no significant effect remained after adjusting for relevant covariates. For women, those in the MAO group had the most adversely affected HRQoL followed by those females in the MHO group. The domain of mobility and impaired HRQoL variable of the MAO and MHO groups remained significant when controlling for all covariates in the model.

CONCLUSIONS

The MANW is the least favorable condition of HRQoL for men, suggesting that metabolic health may associate with HRQoL more than obesity for males. In women, the MAO and MHO groups had the most adversely affected HRQoL, implying that MHO is not a favorable health condition and that obesity, in general, may be strongly associated with HRQoL in women.

Psychological distress as a determinant of changes in body mass index over a period of 10years

OBJECTIVE

To examine the longitudinal relationship between psychological distress and body mass index (BMI) changes over a period of five and ten years.

METHOD

Data were used from the Dutch, prospective, population based Doetinchem Cohort study over the period 1995/1999 until 2005/2009 (N=5504). Psychological distress was assessed using the Mental Health Inventory (MHI-5). BMI (kg/m(2)) was calculated from measured body height and body weight. GEE analyses were used to examine the relationship between psychological distress at baseline and BMI change, and the development of overweight over five years. Linear and logistic regression analyses were used to examine these relations over ten years.

RESULTS

Psychological distress predicted an extra overall increase in BMI of 0.14kg/m(2) (95% CI 0.03-0.25) over five years and an increase of 0.18kg/m(2) (95% CI 0.01-0.35) over ten years, when comparing psychologically distressed participants to psychologically healthy participants. This was especially the case among persons with normal weight (five years; B=0.26kg/m(2), 95% CI=0.12-0.40/ten years; B=0.32kg/m(2) 95% CI=0.11-0.53) and moderate overweight (five years: B=0.18kg/m(2), 95% CI=0.02-0.35) at baseline. Psychological distress did not predict the development of overweight five and ten years later.

CONCLUSION

The results in this study indicated that psychological distress predicted an increased risk in gaining weight, but did not result in an increased risk for developing overweight.

Association between Body Mass Index and Health-Related Quality of Life: The "Obesity Paradox" in 21,218 Adults of the Chinese General Population

BACKGROUND

There was no consistent recognition of the association between high or low body mass index (BMI) and health related quality of life (HRQL). The aim of this research was to study the association between BMI and HRQL in Chinese adults, and to further explore the stability of that association in the subgroup analysis stratified by status of chronic conditions.

METHODS

A total of 21,218 adults aged 18 and older were classified as underweight, normal weight, overweight, class I obese, and class II obese based on their BMI. HRQL was measured by the SF-36 Health Survey. The independent impact of each BMI category on HRQL was examined through standard least squares regression by comparing the difference of SF-36 scores and the minimum clinically important differences (MCID), which was defined as 3 points.

RESULTS

Compared to the normal weight, the class I obese was significantly associated with better HRQL scores in the mental component summary (MCS) (75.1 vs. 73.4, P<0.001). The underweight had the lowest score in both the physical components summary (PCS) (75.4 vs. 77.5, P<0.001) and mental components summary (MCS) (71.8 vs. 73.4, P<0.001). For the MCID, the HRQL score was reduced by more than 3 points in the physical functioning for the class II obese (D=-3.43) and the general health for the underweight (D=-3.71). Stratified analyses showed a similar result in the health subjects and chronic conditions, and it was significant in the chronic conditions.

CONCLUSIONS

The class I obese showed the best HRQL, especially in the mental domain. The worst HRQL was found in the underweight. The class II obese reduced HRQL in the physical functioning only. "Obesity paradox" was more obvious in the participants with chronic conditions.

Associations of subjective vitality with DNA damage, cardiovascular risk factors and physical performance

AIM

To examine associations of DNA damage, cardiovascular risk factors and physical performance with vitality, in middle-aged men. We also sought to elucidate underlying factors of physical performance by comparing physical performance parameters to DNA damage parameters and cardiovascular risk factors.

METHODS

We studied 2487 participants from the Metropolit cohort of 11 532 men born in 1953 in the Copenhagen Metropolitan area. The vitality level was estimated using the SF-36 vitality scale. Cardiovascular risk factors were determined by body mass index (BMI), and haematological biochemistry tests obtained from non-fasting participants. DNA damage parameters were measured in peripheral blood mononuclear cells (PBMCs) from as many participants as possible from a representative subset of 207 participants.

RESULTS

Vitality was inversely associated with spontaneous DNA breaks (measured by comet assay) (P = 0.046) and BMI (P = 0.002), and positively associated with all of the physical performance parameters (all P < 0.001). Also, we found several associations between physical performance parameters and cardiovascular risk factors. In addition, the load of short telomeres was inversely associated with maximum jump force (P = 0.018), with lowered significance after exclusion of either arthritis sufferers (P = 0.035) or smokers (P = 0.031).

CONCLUSION

Here, we show that self-reported vitality is associated with DNA breaks, BMI and objective (measured) physical performance in a cohort of middle-aged men. Several other associations in this study verify clinical observations in medical practice. In addition, the load of short telomeres may be linked to peak performance in certain musculoskeletal activities.

Quality of life after peripheral bypass surgery: a 1 year follow-up

OBJECTIVES

The aim of the study was to assess quality of life (QoL) in patients with peripheral arterial disease (PAD) after aortobifemoral bypass.

METHODS

QoL assessments were completed by 78 patients, 61 (78.2 %) men and 17 (21.8 %) women. QoL was measured, using Medical Outcome Survey Short Form 36 (SF-36), before surgery and 1 year later.

RESULTS

QoL significantly improved after revascularization in about two-third of patients with PAD. Improvement was present in all the SF-36 subscales with the exception of the score for mental health which significantly decreased after operation. Mean SF-36 scores, which were for almost all subscales significantly decreased in patients with PAD in comparison with reference populations, after operation reached or exceeded values of the populations with which they were compared.

CONCLUSIONS

In the present study 1 year after revascularization QoL in patients with PAD was significantly improved in comparison with QoL before operation. Long-term follow-up is needed in order to assess duration of this beneficial effect of bypass surgery.

The health-related quality of life among pre-diabetics and its association with body mass index and physical activity in a semi-urban community in Malaysia--a cross sectional study

BACKGROUND

People with pre-diabetes are at high risk of developing type 2 diabetes and cardiovascular diseases. Measurements of health-related quality of life (HRQOL) among pre-diabetics enable the health care providers to understand their overall health status and planning of interventions to prevent type 2 diabetes. Therefore we aimed to determine the HRQOL and physical activity level; and its association with Body Mass Index (BMI) among pre-diabetics.

METHODS

This was a cross sectional study carried out in two primary care clinics in a semi-urban locality of Ampangan, Negeri Sembilan, Malaysia. Data was collected through self-administered questionnaires assessing the demographic characteristics, medical history, lifestyle and physical activity. The Short Form 36-items health survey was used to measure HRQOL among the pre-diabetics. Data entry and analysis were performed using the SPSS version 19.

RESULTS

A total of 268 eligible pre-diabetics participated in this study. The prevalence of normal weight, overweight and obesity were 7.1%, 21.6% and 71.3% respectively. Their mean (SD) age was 52.5 (8.3) years and 64.2% were females. Among the obese pre-diabetics, 42.2% had both IFG and IGT, 47.0% had isolated IFG and 10.8% had isolated IGT, 36.2% had combination of hypertension, dyslipidemia and musculoskeletal diseases. More than 53.4% of the obese pre-diabetics had family history of diabetes, 15.7% were smokers and 60.8% were physically inactive with mean PA of <600 MET-minutes/week. After adjusted for co-variants, Physical Component Summary (PCS) was significantly associated with BMI categories [F (2,262)=11.73, p<0.001] where pre-diabetics with normal weight and overweight had significantly higher PCS than those obese; normal vs obese [Mdiff=9.84, p=0.006, 95% CIdiff=2.28, 17.40] and between overweight vs obese [Mdiff=8.14, p<0.001, 95% CIdiff=3.46, 12.80].

CONCLUSION

Pre-diabetics who were of normal weight reported higher HRQOL compared to those overweight and obese. These results suggest a potentially greater risk of poor HRQOL among pre-diabetics who were overweight and obese especially with regard to the physical health component. Promoting recommended amount of physical activity and weight control are particularly important interventions for pre-diabetics at the primary care level.

Gender differences in health-related quality of life associated with abdominal obesity in a Korean population

OBJECTIVES

Overall obesity, as measured by body mass index (BMI), has been associated with a low level of health-related quality of life (HRQOL), but little is known about abdominal obesity. This cross-sectional study aimed to determine whether abdominal obesity, as measured by waist circumference (WC), would be significantly associated with HRQOL independent of overall obesity, and if so, whether the association would differ by gender among the Korean population.

DESIGN

Cross-sectional study.

SETTING

South Korea.

PARTICIPANTS

Using data from the 2007-2009 Korea National Health and Nutrition Examination Survey, a total of 13 754 men and women aged 19-65 years were selected, and information about height (cm), weight (kg), WC (cm) and the EuroQOL-5 Dimensions (EQ-5D) scores for HRQOL were taken.

RESULTS

Not only an overall obesity (as categorised into obese, overweight or non-overweight groups based on BMI) but also an abdominal obesity (defined by WC ≥90 cm for men and ≥85 cm for women) was significantly associated with lower EQ-5D scores, after adjusting for age, gender, socioeconomic variables and a number of comorbidities. Even after adjusting BMI effect, the association between abdominal obesity and lower EQ-5D scores remained significant for women, but not for men.

CONCLUSIONS

Among the Korean population aged 19-65 years, abdominal obesity was associated with impaired HRQOL, independently of overall obesity. Furthermore, this association differed by gender, being significant only for women. Therefore, primary healthcare professionals should pay attention to gender differences in the impact of obesity on HRQOL when evaluating population-based health programmes.

Increasing BMI is associated with a progressive reduction in physical quality of life among overweight middle-aged men

We assessed whether increasing body mass index (BMI) affects health-related quality of life in a group of 38 overweight (BMI 25–30 kg/m²) middle-aged (45.9 ± 5.4 years) men, recruited in Auckland (New Zealand). Health-related quality of life was assessed with SF-36v2 at 0, 12, and 30 weeks. Increasing BMI was associated with a progressive reduction in physical component summary score (p = 0.008), as well as lower general health (p = 0.036), physical functioning (p = 0.024), and bodily pain (p = 0.030) scores. Stratified analyses confirmed these findings: participants who were more overweight (n = 19; BMI 27.5–30 kg/m²) had poorer physical component summary (p = 0.005), physical functioning (p = 0.040), bodily pain (p = 0.044), and general health (p = 0.073) scores than the less overweight (n = 19; BMI 25–27.5 kg/m²). Increasing BMI is associated with a progressive reduction in physical quality of life, even within a relatively narrow BMI range encompassing only overweight middle-aged men.

Association between body mass index and health-related quality of life, and the impact of self-reported long-term conditions - cross-sectional study from the south Yorkshire cohort dataset

Background Affinity-Purification Mass-Spectrometry (AP-MS) provides a powerful means of identifying protein complexes and interactions. Several important challenges exist in interpreting the results of AP-MS experiments. First, the reproducibility of AP-MS experimental replicates can be low, due both to technical variability and the dynamic nature of protein interactions in the cell. Second, the identification of true protein-protein interactions in AP-MS experiments is subject to inaccuracy due to high false negative and false positive rates. Several experimental approaches can be used to mitigate these drawbacks, including the use of replicated and control experiments and relative quantification to sensitively distinguish true interacting proteins from false ones. Results To address the issues of reproducibility and accuracy of protein-protein interactions, we introduce a two-step method, called ROCS, which makes use of Indicator Proteins to select reproducible AP-MS experiments, and of Confidence Scores to select specific protein-protein interactions. The Indicator Proteins account for measures of protein identification as well as protein reproducibility, effectively allowing removal of outlier experiments that contribute noise and affect downstream inferences. The filtered set of experiments is then used in the Protein-Protein Interaction (PPI) scoring step. Prey protein scoring is done by computing a Confidence Score, which accounts for the probability of occurrence of prey proteins in the bait experiments relative to the control experiment, where the significance cutoff parameter is estimated by simultaneously controlling false positives and false negatives against metrics of false discovery rate and biological coherence respectively. In summary, the ROCS method relies on automatic objective criterions for parameter estimation and error-controlled procedures. We illustrate the performance of our method by applying it to five previously published AP-MS experiments, each containing well characterized protein interactions, allowing for systematic benchmarking of ROCS. We show that our method may be used on its own to make accurate identification of specific, biologically relevant protein-protein interactions or in combination with other AP-MS scoring methods to significantly improve inferences. Conclusions Our method addresses important issues encountered in AP-MS datasets, making ROCS a very promising tool for this purpose, either on its own or especially in conjunction with other methods. We anticipate that our methodology may be used more generally in proteomics studies and databases, where experimental reproducibility issues arise. The method is implemented in the R language, and is available as an R package called "ROCS", freely available from the CRAN repository http://cran.r-project.org/.

Eating habits and body-weights of students of the university of belgrade, serbia: a cross-sectional study

The purpose of this survey was to quantify the prevalence of overweight and obesity among a sample of students in Belgrade University, Serbia and to describe their main eating habits. A total of 1,624 questionnaire responses were analyzed (response rate 97.3%). The students were recruited during mandatory annual check-ups in April-June 2009. All subjects completed the questionnaire; height (in cm) and weight (in km) were measured by two physicians. Results were assessed statistically. Almost every fourth male student was overweight. Strikingly, 15% of female students were underweight. Highly-significant difference was found between average body mass index (BMI) of male and female students (F=317.8, p=0.001). Students' BMI did not correlate with average family income or with the frequency of taking breakfast (p=-0.064, p=0.152 for males and p=0.034, p=0.282 for females respectively). There is a growing demand for global health strategies which would encourage healthy body-image and figure; thus, these initiatives should mobilize the society on a national and international level.

Health-Related Quality of Life Among Patients With Peripheral Arterial Disease

We evaluated health-related quality of life (HRQoL) among patients with peripheral arterial disease (PAD) and compared the results with those of the general population. We also evaluated the possible association between some demographic and clinical characteristics of patients with PAD and HRQoL. A cross-sectional study involved 102 consecutive patients with verified PAD referred to the Dedinje Vascular Surgery Clinic in Belgrade. The HRQoL was measured using Medical Outcome Survey Short Form 36 (SF-36). Patients with PAD had significantly lower mean SF-36 scores for physical functioning, role-physical, bodily pain, social functioning, role-emotional, and mental health in comparison with the general population. The HRQoL was significantly more impaired in patients with severe PAD. Patients with PAD had a reduced HRQoL compared with the general population. The impact of PAD on HRQoL was independent of other factors related to both the disease and the HRQoL.

Meta-analysis of the association between body mass index and health-related quality of life among adults, assessed by the SF-36

OBJECTIVE

Obesity is associated with impaired overall health-related quality of life but individual studies suggest the relationship may differ for mental and physical quality of life. A systematic review using Medline, Embase, PsycINFO and ISI Web of Knowledge, and random effects meta-analysis was undertaken.

DESIGN AND METHODS

Studies were included in the meta-analysis if they were conducted on adults (defined as age >16 years), reported an overall physical and mental component score of the SF-36, and, or both. Heterogeneity was assessed using I(2) statistics and publication and small study biases using funnel plots and Egger's test. Between-study heterogeneity was explored using meta-regression.

RESULTS

Eight eligible studies provided 42 estimates of effect size, based on 43,086 study participants. Adults with higher than normal body mass index had significantly reduced physical quality of life with a clear dose-response relationship across all categories. Among class III obese adults, the score was reduced by 9.72 points (95% Confidence Interval 7.24, 12.20, P < 0.001). Mental quality of life was also significantly reduced among class III obese (-1.75, 95% confidence interval -3.33, -0.16, P = 0.031), but was not significantly different among obese (class I and class II) individuals, and was significantly increased among overweight adults (0.42, 95% confidence interval 0.17, 0.67, P = 0.001), compared to normal weight individuals. Heterogeneity was high in some categories, but there was no significant publication or small study bias.

CONCLUSIONS

Different patterns were observed for physical and mental HRQoL, but both were impaired in obese individuals. This meta-analysis provides further evidence on the impact of obesity on both aspects of health-related quality of life.

A comparison of health-related quality of life among normal-weight, overweight and obese adults in Qazvin metabolic diseases study (QMDS), Iran

Background:

Obesity is a public health problem that has raised concern worldwide. Numerous epidemiological studies have been showed the relationship between obesity, abdominal fatness and risk of a wide range of illnesses (i.e. diabetes). Obese people experience health-related quality-of-life (HRQL) impairments. The purpose of this study was to evaluate the effect of BMI on Quality of Life, among Normal-Weight, Overweight and Obese adults in Qazvin, Iran.

Methods:

This Cross-Sectional study was conducted on 1103 subjects (aged 20-78 years old) from September 2010 to April 2011 in Qazvin, Iran. The study subjects were selected by multistage cluster random sampling method from residents of mindoodar district of Qazvin. Obesity was defined based on Body Mass Index and SF-36 questionnaire was used as measurement instrument for quality of life. Data were analyzed by Chi-square test, ANOVA and MANOVA.

Results:

A total of 527 men and 576 women were entered the study. Mean BMI was 25.97 ±4.5 Kg/m². The scores of 6 domains were significantly different between 3 groups of BMI. The differences of physical component summary (PCS) and mental component summary (MCS) scores were also significant between normal weight, overweight and obese subjects (p<0.001 and p<0.025, respectively).

Conclusion:

This study underlines the importance of HRQL in overweight and obese individuals. These results suggest that more attention to the obesity and overweight is needed in Iranian population.

BMI and psychological distress in 68,000 Swedish adults: a weak association when controlling for an age-gender combination

Background

Study results concerning associations between body mass index (BMI) and psychological distress are conflicting. The purpose of this study was to describe the shape of the association between BMI and psychological distress in a large sample of Swedish adults.

Methods

Data was measured with the General Health Questionnaire-12 (GHQ-12), in 68,311 adults aged 18–74. Self-reported data was derived from a merger of the 2000, 2004 and 2008 Life and Health (Liv och Hälsa) questionnaires focusing general perceived distress as well as living conditions. Logistic regression analysis was used to describe the association between BMI and psychological distress when controlled for age and gender in combination.

Results

Women reported an overall higher psychological distress than men. A significant pattern of decreasing psychological distress with increasing age emerged among women in all BMI categories. Trends of this same pattern showed for men. Small or no differences were seen in psychological distress between those in normal weight, overweight, and obesity I categories (among women: 20.4%, 18.4%, 20.5%; among men: 12.8%, 11.2%, 12.9%). For both genders, any notable increase in psychological distress appeared first in the obesity II category (among women: 27.2%. Among men: 17.8%).

Conclusions

Psychological distress decreases with increasing age regardless of BMI; a pattern more obvious for women. Being categorized with obesity II leads to a markedly higher psychological distress than being categorized with normal weight, overweight or obesity I. From this, we suggest that future obesity research focusing on psychological distress could investigate the role of stigma and norm susceptibility in relationships where people are evaluated through the eyes of the other.

Impact of lifestyle intervention and metformin on health-related quality of life: the diabetes prevention program randomized trial

BACKGROUND

Adults at high risk for diabetes may have reduced health-related quality of life (HRQoL).

OBJECTIVE

To assess changes in HRQoL after interventions aimed at diabetes risk reduction.

DESIGN, SETTING, AND PARTICIPANTS

A randomized clinical trial, the Diabetes Prevention Program, was conducted in 27 centers in the United States, in 3,234 non-diabetic persons with elevated fasting and post-load plasma glucose, mean age 51 years, mean BMI 34 Kg/m(2); 68 % women, and 45 % members of minority groups.

INTERVENTIONS

Intensive lifestyle (ILS) program with the goals of at least 7 % weight loss and 150 min of physical activity per week, metformin (MET) 850 mg twice daily, or placebo (PLB).

MEASUREMENTS

HRQoL using the 36-Item Short-Form (SF-36) health survey to evaluate health utility index (SF-6D), physical component summaries (PCS) and mental component summaries (MCS). A minimally important difference (MID) was met when the mean of HRQoL scores between groups differed by at least 3 %.

RESULTS

After a mean follow-up of 3.2 years, there were significant improvements in the SF-6D (+0.008, p=0.04) and PCS (+1.57, p<0.0001) scores in ILS but not in MET participants (+0.002 and +0.15, respectively, p=0.6) compared to the PLB group. ILS participants showed improvements in general health (+3.2, p<0.001), physical function (+3.6, p<0.001), bodily pain (+1.9, p=0.01), and vitality (+2.1, p=0.01) domain scores. Treatment effects remained significant after adjusting sequentially for baseline demographic factors, and for medical and psychological comorbidities. Increased physical activity and weight reduction mediated these ILS treatment effects. Participants who experienced weight gain had significant worsening on the same HRQoL specific domains when compared to those that had treatment-related (ILS or MET) weight loss. No benefits with ILS or MET were observed in the MCS score.

CONCLUSION

Overweight/obese adults at high risk for diabetes show small improvement in most physical HRQoL and vitality scores through the weight loss and increased physical activity achieved with an ILS intervention.

Impact of metabolic comorbidity on the association between body mass index and health-related quality of life: a Scotland-wide cross-sectional study of 5,608 participants

Background

The prevalence of obesity is rising in Scotland and globally. Overall, obesity is associated with increased morbidity, mortality and reduced health-related quality of life. Studies suggest that "healthy obesity" (obesity without metabolic comorbidity) may not be associated with morbidity or mortality. Its impact on health-related quality of life is unknown.

Methods

We extracted data from the Scottish Health Survey on self-reported health-related quality of life, body mass index (BMI), demographic information and comorbidity. SF-12 responses were converted into an overall health utility score. Linear regression analyses were used to explore the association between BMI and health utility, stratified by the presence or absence of metabolic comorbidity (diabetes, hypertension, hypercholesterolemia or cardiovascular disease), and adjusted for potential confounders (age, sex and deprivation quintile).

Results

Of the 5,608 individuals, 3,744 (66.8%) were either overweight or obese and 921 (16.4%) had metabolic comorbidity. There was an inverted U-shaped relationship whereby health utility was highest among overweight individuals and fell with increasing BMI. There was a significant interaction with metabolic comorbidity (p = 0.007). Individuals with metabolic comorbidty had lower utility scores and a steeper decline in utility with increasing BMI (morbidly obese, adjusted coefficient: -0.064, 95% CI -0.115, -0.012, p = 0.015 for metabolic comorbidity versus -0.042, 95% CI -0.067, -0.018, p = 0.001 for no metabolic comorbidity).

Conclusions

The adverse impact of obesity on health-related quality of life is greater among individuals with metabolic comorbidity. However, increased BMI is associated with reduced health-related quality of life even in the absence of metabolic comorbidity, casting doubt on the notion of "healthy obesity".

Nutritional status independently affects quality of life of patients with systemic immunoglobulin light-chain (AL) amyloidosis

Nutritional status is an independent prognostic factor in immunoglobulin light-chain amyloidosis (AL), but its influence on quality of life (QoL) is unknown. The aim of this cross-sectional study was to investigate the association between nutritional status and QoL in AL patients at diagnosis. One hundred and fifty consecutive patients with biopsy-proven AL were assessed for nutritional status by anthropometry [body mass index, unintentional weight loss (WL) in the previous 6 months and mid-arm muscle circumference (MAMC)], biochemistry (serum prealbumin), and semiquantitative food intake at referral. QoL was assessed by the Medical Outcomes Study 36-item Short Form General Health Survey. The composite physical component summary (PCS) and the mental component summary (MCS) for AL outpatients were 36.2 ± 10.1 and 44.9 ± 11.3, respectively (p < 0.001 for both vs the population norms of 50). In multivariate linear regression models adjusted for gender, age, Eastern Cooperative Oncology Group performance status, the number of organs involved, the severity of cardiac damage, C-reactive protein, energy intake, and WL, PCS was significantly lower for serum prealbumin <200 mg/L and MAMC <10th percentile (adjusted difference 3.8, 95% CI 0.18-7.5, p = 0.040 and 5.3, 95% CI 2.0-8.7, p = 0.002, respectively). MCS was decreased by 0.47 (95% CI 0.18-0.75, p = 0.002) for each kilogram of body weight lost in the previous 6 months. Nutritional status independently affects QoL in AL patients since diagnosis. Nutritional evaluation should be integral part of the clinical assessment of AL patients. Nutritional support intervention trials are warranted in such patients' population.